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Home My WebLink AboutPermit Electrical 2009-12-7 Electrical Permit Application D 225 Fifth Street+Spdngfield, OR 97477+PH(541)726-3753+FAX(541)726-3689 C- \ iL (.., . ~ t-h-",-, ?V'-<'^ 'f' "' ..,' ..' . e,q. l7?g I';:: "'.D~~e:MMI:NT'us:lfONly....-/1 L,"o.. , ..... ..f...... . ~ d"'. '. .' '.. I Permit no. t- 7 - / '7.3 2:1 I Date: 12-/7 /0'1 I This permit is issued under OAR 9]8-309-0000. Permits are nontransferable. Permits expire if work is not started within ]80 days of issuance or if work is suspended for 180 days. 1;1'"":,,,. "c?I!OGAl::',GOVE.RNMENT;r~~I;\R.OYAIf)sj:tl'jr~'jjij'i'!J~;1 1 Zoning approval'verified? DYes D No I 10:i;?ij;i~l,;:~GATE GO RY;;ifol;ifCONST:Ru.CmloN1t:{ii'~4:~;,":;,~},1 I p(Residential 1 0 Govemment .1 0 Commercial 1~~'j:OBI~SI~E~IINF.OR(lJjA:"':ONlI~N[)!1l!f(jCA'l1I0N~~'it;;l'It::: I Job site address: 4B.t::> 3'(}h- rtA-U::=C I I City 5DV'\~ ell. ,I State: Ore.. I ZIP 97478 I I Refer~nc~'_'\'DES~}P\~ of,wJ;~~,:~t,~\"}jj I 20 AMP .f=XTt3!40)<-- J),~C\:Y7I'/0::... '( -bD 1 .1 :Gx.s( :Y7IALG- CiILG'--I.\T" I ; ;PROP,ERTY,OWNERI Name: JNVlE6 i A//lt/LIL 4.,.flAlTrf I Address: 4,-5<0 3<(::, ~ Pl..AC.~ I City: S ?1<-11\\6Ft6U) 1 State:~1 ZIP: '17'f7i Phone:5'f1-740 2,3353 I Fax: E-mail: ">I'C,\sw.~iA 42..v4co, WYrl This installation is being mad, on residential or farm property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent OAR 479.540(1) ~79560(l)p'.J "-rJ! Signature: ~ ;;c...~1JI\ I ., .::<10NTRACTOR' INSTAl:l::ATION I Business name: 1 Address: I City: 1 Phone: 1 E-mail: I CCB license no.: I BCD license no,: I Signing supervisor's license n_o.: I Print name of signing supervisor:' I Signature of signing supervisor: t,... . I State: '1 Fax: I ZIP: \w .~ 440-2584-J (9/08/COM) I~W#;~,\~iJi,J~~~~~t~{,~11f,j:~~T~'EEE~St HEO'lJ lEE~~l;~;;;y~1i~}f,~~~~~~~1 . ~ ,...__........__'<'.. ','oF."."". ~,.- _',_ _ ......, ... .." _ .. '""",\','h'.,.'cti"-",o.:,;"",~-"ou.,....-.-...53'?'if. 1 ;NUni~e_r;ofj;,i~~~!f~~i:p~i)t~:.;(),:f;'I:Qlfl.';::C()!r~il ::}ota): ,I .- ,,< fl'. ,."',, ,':J , .._t,_,-".,...~,,1<'.,./ ,.;.,~..',.;.!i .. If'..... ,ty,...O\; ....'..".... ~l-.-,.~:l._, d - '. ,{:ost....,.. I Residential, per uni't, servi~e included: I . 11,000 sq. ft. or less (4) $134,00 $ I I Each additional 500 'sq. ft, or portion : $ I thereof . $ 25.00 I Limited energy (2) $ 32.00 $ 1 I Each manufactured home or modular I dwelling service or feeder (2) $ 63.00 $ I Services or feeders: installation, alteration, relocation I 1 200 amps or less (2), . $ 81.00 $ 1 1 201 to 400 amps (2)' $ 95.00 $ 1 1 40 I to 600 amps (2) $158.00 $ 1 60 I to 1,000 amps (2) $205.00 $ I Over 1,000 amps or volts (2) $469.00 $ I Reconnect only (2) , $ 63.00 $ I I Temporary services or feeders: installation, alteration, 'relocation I I 200 amps or less (2) $ 63.00 $ I I 201 to 400 amps (2) $ 87.00 $ I I 401 to 600 amps (2) $126.00 $ lOver 600 amps or 1,000 volts, see services or feeders section above I Branch circuits: new, alteration, extension per panel .1 a. Fee for branch circuits with purchase of a service or feeder fee: I Each branch circuit I $ 6.00 I $ I b. Fee for branch circuits without purchase of a service or feeder fee: 1 First branch circuit (2) I (I $ 55.00 I $ ~ Each additional branch circuit $ 6.00 $ Miscellaneous fees: service or feeder l!ot included I Each pump or irrigatio.n circle (2) $ 63.00 $ 1 Each sign or outline lighting (2) $ 63.00 $ I Signal circuit or a limited-energy panel, $ 63.00 $ alteration, or extension (2) I Each additional inspection: (I) $58.00 $ If~\ttt~~~J1~~)1~~,i~~~~~'GK::~Ntt~~U$-E~~;'~1~1~~ii:fttf~~~;Jt~;:}~~1 (A) Enter subtotal of above fees (Minimum Permit,Fee $58,00) ,I (B) Enter 12% surcharge (.12 x [A]) 1 (C) Technology Fee (5% of[A]) 1 TOTAL fees and surcharges (A through C): $ 15uD :>~ $ 1 $ 1 $ 10'7 fl~ 1 Status Issued CITY OF SPRINGFIELD Bu,ilding/Combination Permit PERMIT NO: COM2009-01738 ISSUED; 12/07/2009 APPLIED: i2l07/2009 EXPIRES; 06/07/2010 VALUE; 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 456 38TH PL ASSESSOR'S PARCEL NO.: 1702311310000 , Springfield TYPE OF WORK: TYPE OF: USE:' Alteration PROJECT DESCRIPTION: Replace ontdoorAC unit with split system heat pnmp- 1 circuit alteration Owner: SMITH JAMES L & ANNE E Address:' 456 N,38TH PL ';res you to SPRINGFIELD OR 97478 ATTENTION: Oregon lawhre6~~aon Utility . _ _ ~,..lf"\r"'Itorl hv t e ~ - 1'- IUIlVH ...... - -. Th 58 rUles al ~ ;:'lJ~ ....... t,. Notifi':.e~~~6R,~I'tmRMj<\!Tffi~1- In O~ bta:ln ~Opl"~ Uy ,l.,! 17- J by 0090. You may 0 , thllJt~).fiR,I112ne ,. Contractor Type Contractor calling the center. (NotU\1i ~1If0\'iiibmion EXpiratIOn Date Phone Electrical OWNER number for the Oregon 332%344). Mcchanical OWNER Center Is 1-600- I BUILDING I~~ORMA nON I # of Units: Primary Occupancy Group: Secondary Occupancy Group: P,:imary Construction Type Secoudary Coustruction Type: # of Bedrooms: ,-" . # of Stories: Height of Structure Type of Heat: Watcr Type: Rangc Type: . NOTICE: Eiie!J:rl''1t~)':fIRE If THE WORK TH.~ .~E!.~~~~,~hl1?\!tig!lpERMIT \~_ilIlOT C~;U~~;E~py~ll~ INJw~f,trrJN,1 ' ANY 180 DAY PEKiuU. : ' . Ovcrlay Dist: # Street Trees Rqd: Pavcd Drive Rqd: oAI of Lot Coverage: ,~..-.,r""'''';'>C.'''''''''''' Lot Size: Sq Ft I st Floor: Sq Ft 2~d Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Front yard Setback: Sidc 1 Setback: Side 2 Setback: Rearyard Setback: Sola r Setbacks: Total: Handicapped: Compact: I PUBLIC IMPROVEME~TS I Street improvements: , Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: Pa2e I of 3 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01738 ISSUED: 12/07/2009 APPLIED; 12/07/2009 EXPIRES: 06/07/2010 VALUE: 225 Fifth Street, Springfield, OR 541.726.3753 Phone 541 ~726.3676 Fax 541.726.3769 Inspection Line I Va.lu~tion De~criJ?tion I Description Tvoe of Construction $ Per Sq Ft or multiplier Sqnare Footage or Bid Amount Value Date Calcnlated Total Value of Project ~ Fee Description . + 12% State Snrcharge + 5% Technology Fee I st Appliance Add, Alter, Extend Cire Minimum/Adjnstment Electrical Amount Paid Date Paid Receipt Nnmber $16.44 12/7/09 2200900000000001353 $6.85 12/7/09 2200900000000001353 $79.00 12/7/09 2200900000000001353 $55.00 12/7/09 2200900000000001353 $3.00 12/7/09 2200900000000001353 Total Amount Paid $160.29 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769, All inspections requested before 7:00 a.m. will be made the same working day, insp,~ctions requested after 7:00 a.m. will be made the following work day. I Rp~npPtio~ Rough ~Iectric: Pri~l; to Cover Final Electric: When all electrical work is complete. .' Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. :\' ,,: 'Paee 2 of3 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 71:0";.....4i."".' i.. M;:, , , , . -'.' ',' ^ ,.~,,' .,.-..- .,_.......','~ -- City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2009-01738 COM2009-0 1 738 COM2009-0 1738 COM2009-0 1 73 8 COM2009-01738 Payments: Type of Payment Crcd itCard cReceinll RECEIPT #: 2200900000000001353 Date: 12/07/2009 Description 1st Appliance Add, Alter, Extend Circ Minimum/Adjustment Electrical + 5% Technology Fee + 12% State Surcharge Paid By JAMES SMITH ~tem Total: L:heck Number Authorization Rece!ved Qy, Batch Number Number How Received cjc 093293 In Person Payment Total: . I,ll 'r~' Page I of I 1:18:04PM Amount Due 79.00 55,00 3,00 6,85 16.44 $16U.29 Amount Paid $ 1 60,29 $16U.29 12/7/2009 By signature, Istute and agree, that J have carefully examined the completed application and do hereby certify thllt all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Servihs Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensnre that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of thc property, and the approved set of plans will remain on the site at aU times during construction. Ow~=""~ Status Issued 225 Fifth Street, Spl'inglield, OR 541-726-3753 Phone 541-726-3676 Fax 541- 726-3769 Inspection Line Paee 3 of3 CITY OF SPRINGFIELD Bu,ilding/Combination Permit PERMIT NO: COM2009-01738 ISSUED: 12/07/2009 APPLIED: 12/07/2009 EXPIRES: 06/07/2010 VALUE: / ~ .~o-;. f Date , >, COlllstruction Contractors Board 700 Summer St.NE Suite 300 _' PO Box 14140 , 'j , Salem' OR' 97309-5052' ..' \. ./ Phone: 503-378-4621 ...., .,.'. Web Address: www.ccb.state.or.us Pennit #: G}7~ /7S6 i-/~ & 3 gtA ?t.- ~ . .. Address:- Issued by: Date: 12;/ yO? :.. '"I ..- .,+ ; ,.' Statement: Information Notice to Property Owners , ',About c'onstruction Responsibilities:' .' , , . Note: Oregon Law, ORS701.055(4) requires residentidlconsiruction permit applicants whoare"not licensed with the Construction Contractors Board to sign the following statement before a building permit"can be issued. This statement is requiredfor residential'building, electrical"mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 70rOIO(7), need not submit this statement. This statemen~iwill befiledwith the permit. ~il i he appwp,;atebl~s and initial p~xe~ I and 2, and either box 3A or 3B: .. ,0_ I, I own, reside in, or will reside in the completed structure. . ' /)f.2 J -',' I understarid that I must become licensed as a construction con~ictor if the' structure is sold or . ~ offered for sale before or'on completion,- o 3A. 'My general contractor is ' (N~e) ,. , ~ (CCB #) .. . 'I will instrU~t my general-c~ntractortiiat all subcontract~rswho work oil Ihe'structure must be, licensed with the Construdioli Contractors ,Board, (\ d. ' OR .' r ~J 3B. I will be ~y o~ gen~!alcontractor: If! hire sllbcontractors, Twill hire only subcontractors licensed with the Construction Contractors .. Board. If! change my mind and hire a general contractor, I will contract with a contractor who is ' licensed with the CCBand will immediately notify the office issuing this building permit ofth.e ' name ofihe:contractor. ' ,I hereby certify that the above information is correct and,that I have read and do understand the Information Notice toPrope!iY Owners about Constructio~ Responsibilities on, the re~erse side of,this 'forll!.;', . ~(1~..~', ,~,",. ,'~J1'b~jdJ9 ,~(Signatureofpermit,apPlicant) , ' ,r , '(Datf,. r (White copy to issuing agency permit file, pink copy to applicant.) -.' ( .. .' " ' Property _ o~er,doc, 06.01:04 . , , \' .- .. , . '. ACtingas:-Your.'Own General Contraotol7?' ,~' :. :;:-- ...1 .~ -. -.. _ . , .' '\ TO'. t..... ': ~ INfORMATION NOTICE 'TO :PROPERTY OWNER'S ','_- ABOUT CONST,RUCTIONRESPONSIBILlTIES: -..-'-' . '.' ;~ .,;.,...... .."".. ,,' ':.!p~,.J: '"' ::;'.t': ..~;r .. .. -., ., -. . ~.. , , NOTE This Information Notice to Property Owners about Construdion Responsibilities was,developed by the ConstructiGln Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. --;'.'~':>:-:-\;."~_ <r,.., ~.". '. '", ..-: '~/~'."'-~l, .>:" . ,.-~.'-""-' "-<.1 .'.j..l1....;---<:t:=-.. ~'-...._-. If you are acting as your own contractor to construct a new home' or make a substantial improvement to an existing structure, you can prevent'inany problems b'y bejng liwareoftbe followingrespbn~ibilities and. concerns. ," ,_ c.:: _ ".' E~pl,oy~~ .~e.sp~~sibilities", ' ;,\' You,yvill, in 11\ost.in.~!ance,s,be.fUled to.be ~ "eplployer" and,the ~o~tractors you contract~tii'wiJl be "ellfployees" if . '. .~. . , .... .. , you:u~e contr~ct?.rs n?t Ij,c~n~~d :,vith!~1S~0.rstr."stjon Contractor.~ j30arQ tp do labo~.41 constructing <;>,to ~ssist in the _ construction or improvement of a:residential structure, As'the employer, you must comply with the following: . ~ !"'-~"-.""'~' ", ..';~,-"'. ,--.,.'~'.~-.....!: .. ."'... ..'... " ...- .-\-". ~' .' r . ,.,', ,:". '. '_. . ~. '_ '. " ,'.' .',. ':' ! \ :, ." '.. e', '. '. . ,:. ,.... . Oregon's Withholding Tax Law: As an employer, you must'withh6ld income taxes froin,employee'wages at the time employees are paid, You wil1:be,Jiable for the tax,pay,ments evenifyoud(l!,!'t actually,Wit[tholdthe tax from your_ employees. For more infonriation;"Jalnhe'D~j,a. ~,~,ent o(Revenue at 503.3784988. ' "", ..: . ' , '.< ,'.: , " ' , '"","7' I , Unemi>lo~'lIlcnt In~tirancc Tax: As an employer;yolfarerequired to pay a tax.for unemploymenLinsurancepurPose~.: on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488, , " \~, 'It.., ,~~i;tF~:=';,'.:J:;l-_."+: .....;,~'t:!. _' .. ~.:y ;~~,;:.!'r~,':t ~."I.' L" j:tT~' ".," ~~~'1Ir");. ..; The Oregon Busilless. Id~ntification Number (BIN) is a combirt~<!;:nl!!Jlb"r:. for .b.o,th, Oregq!l. Withh.o\ding and \ Unemployment Insurance Tax, To file fora BIN, call 503-945-8091 or www,dor,state.oLus/formsnav.htmll for the alJP!VpJ.~ate fonns. . . , (~.~. ,.c. _ Work~rs~-Conip~nsation Insurance: As an einployefifbu '~re subject to the Oregon Workers'Compensation Law, and must, obtain workers' compensation insurance for your employ,ees. If you fail to obtain workers' compensation ;nsnra~'&~, xo~ 6oillabc"imbJeid top~halti€s1aildbe.liaJjie'forTall ci'iiiin. costs if6neofyoiIT erilpfoy~es isinjUi-ed on the job, For more information; 'call the''W orkers' Compensation Divisioi...atthe' Department 'of' cons'wner'and Business Services at 503-947-7815. -.-.-: .:" ..< ~, ....;.. -t. '. .~-.,# ... t t-:.:-' ."~ :l. ... - ~ - "-' U.S. Internal Revenu~ S':'rvice: As an employer, 'you must withhold'fedCraliricorije~taX;from employees' w~ges'.; :". ) You will be liable for the tax payment even if you didn't actually Withhold the tax. For a Federal 'EIN number, call the IRS;at:l~800-829'4933'orvisit,their,web site at wivw.irs,QOV" ,;"".' . ," ,,' >' ....,: .... ~', , \ .,,:.1- ~. -J.1. , ......:' ~~',7,..r"""d'''IJ:I''''fl.,~,'')~' .;-;.;.":~:....'l-. "h~":',F -. ~'1".~-:", .1:-..:1 ,.;Other,Res,pQ.n!!il:>jJities a~9 A.re~!l.9.f ~on'ceril~J;"" '. : I. Code Compliance: As the permit holder' for this project, you are responsible for resbjving an:Y'f~iliire'ibiheet code requirements ,that may be brought to 'your attention through inspections: '. ,,~'~-'~','. ~_: ~.... ':~"";,:".."1 .,.,....... " ,".' .. .":' ..... .Rr~ II Liability' and Prop'eftyDam'aglttnsiIrante:" Contact 'your' insui~hce' agent to see if youhaveadeqiJate ,insuranc'e: ,1 coverage fot accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire Or work that must,be'recjone, , / i ,i , --~,,- , ''-.- _ " _.: ~_'.~ '__-.- ~_~.~'> \ _ ~,. _ _. ..____ n J....j .}.:.' t' . _ \ L~~' (~ Time: Make sure yo'':1have sufficient tii11e to supervise your employees. _ .. '0.;.,':,:" \ . - ' ", . - .: ~ .:- ;.~\' ".-. ..... . '''}l .:... ...'. _ ) '. . ..-' ." . Expertise: Make sure you have the skills'to act as your oWn general contractor, to coordinate.the work of rough-in and fmish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions cail the Construction Contractors Board (503-3784621) or write the agency at PO Box 14140, Salem, OR 97309c5052.. . +-- :.;., '../ . ,'; \ Property_owner.doc 06.01-04 . '